Presentation to Family Voices of California Healthy Families Program Transition to Medi-Cal
|
|
- Britney Ross
- 6 years ago
- Views:
Transcription
1 Presentation to Family Voices of California on Healthy Families Program Transition to Medi-Cal August 21, 2013
2 Agenda Overview of the Healthy Families Transition Brief Comparison of Benefits Between HFP & Medi-Cal Overview of the Completed Transition Efforts Overview of Phases 4A and 4B Transition Efforts What Professionals and Providers Should Know Contact Information Q & A 2
3 Overview of Transition Children in HFP ages 0 through 18 with incomes up to and including 250 percent of the Federal Poverty level (FPL) New optional Targeted Low Income Children s (TLIC) Program covers new enrollees of ages 0 through 18 with income up to and including 250 percent FPL Goals of Transition Collaboration and Coordination Monitoring Reports Mental Health Screening 3
4 Brief Comparison of Benefits ELIGIBILITY Healthy Families Medi-Cal Age Limit of a Child Up to age 19 1 Up to age 21 HEALTH BENEFITS Healthy Families Medi-Cal Acupuncture 20 visits/benefit year 2 2 visits/month Biofeedback Covered 3 Covered Blood and Blood Products Covered Covered California Children s Services (CCS) Program Services Covered Covered Cataract Spectacles and Lenses, Cataract Contact Lenses Covered Covered Chiropractic Services 20 visits/benefit year 4 2 visits/month Clinical Cancer Trials Covered Covered Diabetic Care Covered Covered Diagnostic, X-Ray and Laboratory Services Covered Covered Durable Medical Equipment Covered Covered Emergency Health Care Services Covered Covered 1 Currently under the HFP, once a child turns19, s/he is referred to Medi-Cal for a determination under the Medically Needy program which may include being assessed for share-of-cost Medi-Cal. 2 Not all health plans provide this option. 3 Not all health plans provide this option. 4 Not all health plans provide this option. 4
5 Completed Transition Efforts Population Total Number of Children Transitioned Phases 1A, 1B, and 1C - Total transitioned: 385,601 Phase 2 - Total transitioned: 228,152 Phase 3 - Total transitioned: 104,915 Enrollments Jan 2013 Feb 2013 Mar 2013 May 2013 Jun ,737 21,660 11,941 83,719 23,535 19,207 Disenrollments Jan 2013 Feb 2013 Mar 2013 May 2013 Jun ,964 11,192 37,697 20,837 5
6 Completed Transition Efforts Access to Health Care Percentage of Children Assigned a Primary Care Physician Jan 2013 (Phase 1A) Mar 2013 (Phase 1B) (Phase 2) May % 93.88% 95.44% 98.14% 99.72% Percentage of Children Changing their Primary Care Physicians Jan 2013 (Phase 1A) Mar 2013 (Phase 1B) (Phase 2) May % 6.07% 14.81% 20.67% 27% 6
7 Completed Transition Efforts Access to Health Care (cont.) Percentage of Children Maintaining their Health Plans Jan 2013 (Phase 1A) Mar 2013 (Phase 1B) (Phase 2) May % 100% 99.24% 99.48% 99.73% Percentage of Children Changing their Health Plans Jan 2013 (Phase 1A) Mar 2013 (Phase 1B) (Phase 2) May % 0% 0.07% 0.05% 0.04% Percentage of Children Changing to FFS Jan 2013 (Phase 1A) Mar 2013 (Phase 1B) (Phase 2) May % 0% 0.69% 0.47% 0.23% 7
8 Completed Transition Efforts Access to Dental Care Percentage of Warm Transfer w/ Successful Referrals (CoC) Jan 2013 Feb 2013 Mar 2013 May 2013 Jun % 100% 100% 100% 100% 100% Percentage of successful referrals resulting in scheduled appointments (CoC) Jan 2013 Feb 2013 Mar 2013 May 2013 Jun % 99% 98% 92% 87% 85.7% 8
9 Completed Transition Efforts Access to Dental Care (cont.) Number of Newly Enrolled FFS & Dental Providers Jan 2013 Feb 2013 Mar 2013 May 2013 Jun Number of Disenrolled Dental Providers Jan 2013 Feb 2013 Mar 2013 May 2013 Jun
10 Completed Transition Efforts Access to Mental Health Care Number of Transitioned Children Receiving Services Jan 2013 Feb 2013 Mar 2013 May 2013 Jun ,028 1,187 1, Data Not Yet Available Number of OTLIP Children Receiving Services Jan 2013 Feb 2013 Mar 2013 May 2013 Jun Data Not Yet Available 10
11 Completed Transition Efforts Access to Substance Use Disorder Services Number of Children Receiving Services Jan 2013 Feb 2013 Mar 2013 May 2013 Jun Data Not Yet Available Data Not Yet Available 11
12 Phases 4A and 4B Transition Phase 4A No sooner than September 1, 2013 Approximately 7,200 Children to Transition Phase 4B No sooner than November 1, 2013 Approximately 25,000 Children to Transition 12
13 What Professionals & Providers Should Know For Phase 4A & Phase 4B: Provider to Member Ratio Physician Extenders Health Plan Reassessments Provider Network Capacity 13
14 Contact Information DHCS Transition Webpage DHCS Box for Information/Questions MRMIB Transition Webpage MRMIB Box for Information/Questions 14
15 Questions and Answers 15
Medi-Cal Program. Benefit. Benefits Chart
Chart Please note that the table below is only a summary. More details about benefits can be found in the section of the Medi-Cal Evidence of Coverage booklet. All health care is arranged through your
More informationScripts for the Transition to Medi-Cal
Scripts for the Transition to Medi-Cal Question: Where can we get the latest information on the transition plan? The State Law has changed and requires children enrolled
More informationSB 75 Full Scope Medi-Cal for Children. SF Health Network - Community Behavioral Health Services June 21, 2016 Maria Jimenez Barteaux, CBHS Billing
SB 75 Full Scope Medi-Cal for Children SF Health Network - Community Behavioral Health Services June 21, 2016 Maria Jimenez Barteaux, CBHS Billing Senate Bill 75 Welfare & Institutions Code, Section 14007.8
More informationDuals Demonstration. An Overview for Home Medical Equipment Providers
Duals Demonstration An Overview for Home Medical Equipment Providers Overview Background Medi-Cal Delivery Models State Budget Coordinated Care Initiative Duals Demonstration Overview Goals Population
More informationHEALTHY FAMILIES PROGRAM TRANSITION TO MEDI-CAL
HEALTHY FAMILIES PROGRAM TRANSITION TO MEDI-CAL NETWORK ADEQUACY ASSESSMENT REPORT PHASE 1 November 1, 2012 Submitted by the California Department of Managed Health Care in Fulfillment of the Requirements
More informationGold Coast Health Plan Provider Operations Bulletin
Gold Coast Health Plan Provider Operations Bulletin May 15, 2013 Edition : POB-009 Table of Contents Section 1: Treatment of CCS Eligible Conditions... 3 Section 2: GCHP HEDIS Documentation Tips... 4 Section
More informationProvider Responsibilities: Health Assessments
Provider Responsibilities: Health Assessments 1 This section includes information about the two categories of providers who may render Child Health and Disability Prevention (CHDP) services, outlines the
More informationCalifornia Children s Services (CCS) Program Medi-Cal Managed Care CCS Whole-Child Model Comparison Chart January 6, 2016
California Children s Services (CCS) Program Medi-Cal Managed Care CCS Whole-Child Model Comparison Chart January 6, 2016 Authorization for Services Plan to adjudicate authorization request. Authorization
More informationBenefit Explanation And Limitations
Benefit Explanation And Limitations SFHP providers supply many medical benefits and services, some of which are itemized on the following pages. For specific information not covered in this table, please
More informationBenefit Coverage (Cal. Code Regs., tit. 22, 51328, ) (DHCS Contract , Amend. 10, Exhibit A, Attach. 11, 7)
Revised: January 2004 Chemical Dependency Rehabilitation Benefit Coverage (Cal. Code Regs., tit. 22, 51328, 51341.1) (DHCS Contract 04-35765, Amend. 10, Exhibit A, Attach. 11, 7) Health care services necessary
More informationHealth Care Reform 1
Health Care Reform 1 Health Care Reform Covered California (Health Benefit Exchange) Medi-Cal Expansion Bridge Plan Proposal Gold Coast Readiness Outreach to the Eligible 2 Health Care Reform: What is
More informationCAL MEDICONNECT: Understanding the Health Risk Assessment. Physician Webinar Series
CAL MEDICONNECT: Understanding the Health Risk Assessment Physician Webinar Series Today s Webinar This webinar is part of a series designed specifically for CAPG members. For a general overview of the
More informationExtended Continuity of Care for Seniors and Persons with Disabilities Frequently Asked Questions. September 2011
Extended Continuity of Care for Seniors and Persons with Disabilities Frequently Asked Questions September 2011 Question #1: If a beneficiary s current fee-for-service (FFS) Medi-Cal doctor does not accept
More informationDriving Quality Improvement in Managed Care. Toby Douglas, Director California Department of Health Care Services
1 Driving Quality Improvement in Managed Care Toby Douglas, Director 2 Presentation Overview 1. Background on California s Medicaid Program (Medi-Cal) 2. California s Quality Improvement Focuses 3. Challenges
More informations n a p s h o t Medi-Cal at a Crossroads: What Enrollees Say About the Program
s n a p s h o t Medi-Cal at a Crossroads: What Enrollees Say About the Program May 2012 Introduction Medi-Cal, which currently provides health and long term care coverage for more than 7.5 million Californians,
More information6/19/2018. L.A. Care Health Plan Benefits. L.A. Care Local Initiative: History. L.A. Care Health Plan
L.A. Care Health Plan Benefits Melissa Gutierrez, Director of Sales & Business Development Phoi Tran, Specialist, Business Development Margarita Lopez, Field Manager 1 L.A. Care Local Initiative: History
More informationMEDI-CAL MANAGED CARE OVERVIEW
MEDI-CAL MANAGED CARE OVERVIEW July 2018 Sandy Damiano, PhD Deputy Director DHS Primary Health Eligibility & Enrollment Apply for Medi-Cal year round: County Department of Human Assistance (DHA) Online,
More informationExecutive Director s Report
Executive Director s Report Peter V. Lee Executive Director California Health Benefit Exchange Board Meeting December 18, 2012 Covered California Board Calendar 2013 Month / Date January 17 February 21
More informationCalifornia s Health Homes Program
California s Health Homes Program HPSM Network Webinar 9/05/18 Goals for Today: Health Homes Program overview CB-CME requirements Program readiness and implementation timeline Gather take-away questions
More informationState of California Health and Human Services Agency Department of Health Care Services
State of California Health and Human Services Agency Department of Health Care Services TOBY DOUGLAS DIRECTOR EDMUND G. BROWN JR. GOVERNOR DATE TO: ALL COUNTY WELFARE DIRECTORS ALL COUNTY WELFARE ADMINISTRATIVE
More informationSummary Of Benefits. CALIFORNIA Imperial, Los Angeles, Riverside (partial), San Bernardino (partial), and San Diego
Summary Of Benefits CALIFORNIA Imperial, Los Angeles, Riverside (partial), San Bernardino (partial), and San Diego 2018 Molina Medicare Options Plus (HMO SNP) (800) 665-0898, TTY/TDD 711 7 days a week,
More informationPersonal Responsibility in Medicaid
Personal Responsibility in Medicaid Chris Perrone Director, Improving Access HMA Conference 2017 The Future of Medicaid Is Here September 12, 2017 3 Questions Context: What problems are we trying to solve?
More informationInformation for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service)
Information for Dual-Eligible Members with Secondary Coverage through California January 1, 2011 December 31, 2011 Los Angeles County This publication is a supplement to the 2011 Positive (HMO SNP) Evidence
More informationBlueChoice HMO HSA/HRA Silver 2000 Integrated Deductible
BlueChoice HMO HSA/HRA Silver 2000 Integrated Deductible Summary of Benefits Services In-Network You Pay 1 FIRSTHELP 24/7 NURSE ADVICE LINE Free advice from a registered nurse. Visit www.carefirst.com/needcare
More informationMEDI-CAL PROGRAM LOS ANGELES COUNTY DEPARTMENT OF PUBLIC SOCIAL SERVICES - DPSS
MEDI-CAL PROGRAM LOS ANGELES COUNTY DEPARTMENT OF PUBLIC SOCIAL SERVICES - DPSS W O R K F O R C E D E V E L O P M E N T B O A R D A J C C P A R T N E R S MEDI-CAL PRESENTATION Medi-Cal Overview Health
More informationMEDI-CAL MANAGED CARE OVERVIEW
MEDI-CAL MANAGED CARE OVERVIEW September 2016 Sandy Damiano, PhD Deputy Director DHHS Primary Health Eligibility & Enrollment Open year round Based on income and family size Simplified procedures Income
More informationJuly 13, RE: Comments on Whole Child Model Documents. Dear CCS Redesign Team:
Children's Regional Integrated Service System Hemophilia Council of California July 13, 2016 California Children s Services Redesign Team California State Department of Health Care Services 1501 Capitol
More informationRSNA EMPLOYEE BENEFIT TRUST PLAN II S2502 NON GRANDFATHERED PLAN BENEFIT SHEET
BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Standard COB Dependents Children birth to age 26 Filing Limit 1 year from date of service Mailing Address & PPO Company. Remit claims to:
More informationBenefit Explanation And Limitations
Benefit Explanation And Limitations SFHP providers supply many medical benefits and services, some of which are itemized on the following pages. For specific information not covered in this table, please
More informationLocal Solutions for Serving the Remaining Uninsured: Benefits and Financing
Local Solutions for Serving the Remaining Uninsured: Benefits and Financing Presenters: Bob Brownstein, Working Partnerships USA Cynthia Carmona, Community Clinic Association of Los Angeles County David
More informationMaryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012
Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint
More informationAnthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training
Anthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training Anthem Blue Cross Cal MediConnect Plan Effective January 1, 2015, Anthem Blue Cross
More informationBenefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
PLAN FEATURES Annual Deductible The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Hearing aid reimbursement does not apply to the out-of-pocket
More informationDrug Medi-Cal Waiver Evaluation Planning
Drug Medi-Cal Waiver Evaluation Planning Darren Urada, Ph.D. UCLA Integrated Substance Abuse Programs January 5, 2015 The author s views and recommendations do not necessarily represent those of the funders,
More informationLaurie A. Soman Lucile Packard Children s Hospital CRISS
Laurie A. Soman Lucile Packard Children s Hospital CRISS 1 Birth of CCS Program CCS Program Established in 1927 for Orthopedically Handicapping Conditions CCS Originally Crippled Children s Services Response
More informationHealth Coverage for San Franciscans
Health Coverage for San Franciscans SF FES Council Affordable Care Act Alejandro Salinas LaShenna Sirles July 16, 2014 The following presentation is not for consumer use and is for informational purposes
More information14. Health Care Options (HCO)/Managed Care
Medi-Cal Handbook page 14-1 14. 14.1 Fee-For-Service Health care is provided to certain Medi-Cal beneficiaries through Fee-For-Service benefits. This means that some Medi-Cal clients may receive medical
More informationIV. Benefits and Services
IV. Benefits and A. HealthChoice Benefits This table lists the basic benefits that all MCOs must offer to HealthChoice members. Review the table carefully as some benefits have limits, you may have to
More informationDate of Last Review. Policy applies to Medicaid products offered by health plans operating in the following State(s) Arkansas California
POLICY: Anthem Medicaid (Anthem) is responsible for providing Access to Care/Continuity of Care and coordination of medically necessary medical and mental health services. Members who are, or will be,
More information2015 Summary of Benefits
2015 Summary of Benefits Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) Los Angeles County, CA H3237_2015_0291 CMS Accepted 09082014 Health Net Cal MediConnect Summary of Benefits! This is a
More informationFreedom Blue PPO SM Summary of Benefits
Freedom Blue PPO SM Summary of Benefits R9943-206-CO-308 10/05 Introduction to the Summary of Benefits for Freedom Blue PPO Plan January 1, 2006 - December 31, 2006 California YOU HAVE CHOICES IN YOUR
More informationCovered Services List and Referrals and Prior Authorizations for MassHealth Members enrolled in Partners HealthCare Choice
Covered Services Covered Services List and s and Prior Authorizations for MassHealth Members enrolled in Partners HealthCare Choice This chart tells you two things: 1. the covered services and benefits
More informationMedicaid Benefits at a Glance
Medicaid Benefits at a Glance Mountain Health Trust Benefits Children (0 up to 21 years) Ambulatory Surgical Center Services Any distinct entity that operates exclusively for the purpose of providing surgical
More informationMEDICARE CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS.
ine 1-800-544-0088 www.care1st.com CARE1ST DUAL PLUS PLAN SUMMARY OF BENEFITS MEDICARE 2009 COUNTIES: LOS ANGELES - ORANGE - SAN BERNARDINO - SAN DIEGO H5928_09_004_SNP_SB 10/2008 Section I Introduction
More informationCovered Services List
CAREPLUS Covered Services List For CeltiCare Health with MassHealth CarePlus Coverage This is a list of all covered services and benefits for MassHealth CarePlus enrolled in CeltiCare Health. The list
More informationThe Budget: Maximizing Federal Reimbursement For Parolee Mental Health Care Summary
The 2013-14 Budget: Maximizing Federal Reimbursement For Parolee Mental Health Care MAC Taylor Legislative Analyst MAY 6, 2013 Summary Historically, the state has spent tens of millions of dollars annually
More information2018 Benefit Highlights
Orange County 2018 Benefit Highlights SCAN Plus (HMO) Medicare Advantage Plan What Are Additional Benefits and Services? Additional Benefits are benefits and services not offered by Original Medicare.
More informationFREEDOM BLUE PPO R CO 307 9/06. Freedom Blue PPO SM Summary of Benefits and Other Value Added Services
FREEDOM BLUE PPO R9943 2007 CO 307 9/06 Freedom Blue PPO SM Summary of Benefits and Other Value Added Services Introduction to Summary of Benefits for Freedom Blue January 1, 2007 - December 31, 2007 California
More informationInformation for Dual-Eligible Members with Secondary Coverage through California Regular Medi-Cal (Fee-for-Service)
Information for Dual-Eligible Members with Secondary Coverage through California January 1, 2015 December 31, 2015 Los Angeles County This publication is a supplement to the 2015 Evidence of Coverage and
More informationFOR IMMEDIATE RELEASE April 17, Media Line Contacts: Covered California (916)
FOR IMMEDIATE RELEASE April 17, 2014 Media Line Contacts: Covered California (916) 205-8403 California Department of Health Care Services (916) 440-7660 COVERED CALIFORNIA S HISTORIC FIRST OPEN ENROLLMENT
More informationAnthem Blue Cross. CCHCA Physician Handbook (7 th Edition) Updated 3/15
Part II Section B Anthem Blue Cross Introduction 1 Verifying Member Eligibility and Benefits 1 Sample Anthem Blue Cross Member ID Card 2 Anthem Blue Cross Managed Medi-Cal Program 4 CCHCA Physician Handbook
More informationAnthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your Network: California Care HMO
Anthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your : California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary
More informationOnline Eligibility Training will be held via WebEx on
Online Eligibility Training will be held via WebEx on Thursday, August 4 th, 2016 at 02-3:00 PM or Tuesday, August 9 th, 2016 at 11-12:00 Noon Presented by BHS Billing Unit 1380 Howard Street, SF 94103
More informationCalifornia Children s Services Program Redesign
California Children s Services Program Redesign Redesign Stakeholder Advisory Board Meeting #4 Focus: Whole-Child Model June 22, 2015 Agenda 9:30-9:55 Registration, Gather and Networking 10:00-10:15 Welcome,
More informationSan Francisco Health Plan. Evidence of Coverage and Disclosure Form
San Francisco Health Plan Evidence of Coverage and Disclosure Form 2016 Welcome to the San Francisco Health Plan San Francisco Health Plan (SFHP) is here to help you with your health care needs. Let s
More informationCorporate Services Employment Report: January Employment by Staff Group. Jan 2018 (Jan 2017 figure: 1,462) Overall 1,
Corporate Services Employment Report: January Employment by Staff Group Jan (Jan 20 figure: 1,462) Jan % Overall 1,520 +58 +4.0% 8 Management (VIII+) 403 +52 4.8% Clerical & Supervisory (III to VII) 907
More informationMultipurpose Senior Services Program. Coordinated Care Initiative. Transition Plan Framework and Major Milestones. January 2018 VERSION 1.
Multipurpose Senior Services Program Coordinated Care Initiative Transition Plan Framework and Major Milestones VERSION 1.1 Contents Purpose... 1 Background... 1 Major Activities and Milestones... 2 Transition
More informationFACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6
FACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6 Low Income Assistance: Cal MediConnect What is Cal MediConnect? California is 1 of 15 states that has signed a Memorandum of Understanding
More informationKern Medical Center Health Plan
Managed By UCLA Spring Convening on HCCI Kern Medical Center Health Plan Vision An integrated healthcare network Neighborhood access to primary care Enhanced access to specialty and diagnostic care Coordination
More information101 Grove Street, Room 308 San Francisco, California (415) MANAGED CARE UPDATE FY
101 Grove Street, Room 308 San Francisco, California 94102 (415) 554-2610 www.sfdph.org MANAGED CARE UPDATE FY 2013-14 TABLE OF CONTENTS 1. DPH Enrollment 1 2. Low Income Health Program Transition 3 3.
More informationAnthem Blue Cross Your Plan: Modified Classic HMO 15/30/250 Admit/125 OP Your Network: California Care HMO
Anthem Blue Cross Your Plan: Modified Classic HMO 15/30/250 Admit/125 OP Your : California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process.
More informationMultipurpose Senior Services Program. Coordinated Care Initiative. Transition Plan Framework and Major Milestones. October January 2018 DRAFT
Multipurpose Senior Services Program Coordinated Care Initiative Transition Plan Framework and Major Milestones October January 2018 DRAFT VERSION 1.01 Contents Purpose... 1 Background... 1 Major Activities
More informationVivity offered by Anthem Blue Cross Your Plan: Custom Classic HMO 25/45/500 Admit /250 OP Your Network: Vivity
Vivity offered by Anthem Blue Cross Your Plan: Custom Classic HMO 25/45/500 Admit /250 OP Your : Vivity This summary of benefits is a brief outline of coverage, designed to help you with the selection
More informationFlorida Medicaid: Performance Measures (HEDIS)
Florida Medicaid: Performance Measures (HEDIS) Justin M. Senior Florida Medicaid Director Agency for Health Care Administration Senate Health Policy October 20, 2015 Statewide Medicaid Managed Care (SMMC)
More information2016 Summary of Benefits
2016 Summary of Benefits Health Net Jade (HMO SNP) Kern, Los Angeles and Orange counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0175 CMS Accepted 09082015
More informationWho we are. choose IEHP* *Source: DHCS Medi-Cal Enrollment by Health Plan
Overview 1. Who is Inland Empire Health Plan 2. Who We Serve 3. Program: Medi-Cal & Cal MediConnect 4. Benefits of Joining IEHP 5. Helpful Resources 6. IEHP Community Resource Center 7. How to Join IEHP
More informationMedi-Cal s Most Costly FFS Populations
Medi-Cal s Most Costly FFS Populations A Look At The Population, Costs, And Diseases Prepared by DHCS Research and Analytical Studies Section 1 Which Populations Drive Medi-Cal FFS Provider Payments? The
More informationAnthem Blue Cross Your Plan: Modified Classic HMO 20/40/250 Admit /125 OP Your Network: California Care HMO
Anthem Blue Cross Your Plan: Modified Classic HMO 20/40/250 Admit /125 OP Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection
More informationVivity offered by Anthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your Network: Vivity
Vivity offered by Anthem Blue Cross Your Plan: Custom Premier HMO 10/100% Your : Vivity This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary
More informationMedi-Cal Expansion & Health4All Kids: Tools and Resources for Communities. April 20, 2016 health4allkids.org
Medi-Cal Expansion & Health4All Kids: Tools and Resources for Communities April 20, 2016 health4allkids.org Introduction Mayra Alvarez President and CEO The Children s Partnership 2 Welcome Sponsored by:
More informationCongressional Regional Plan BlueChoice HMO Referral Gold 80 Non-Integrated Deductible
Congressional Regional Plan BlueChoice HMO Referral Gold 80 Non-Integrated Deductible Summary of Benefits Services In-Network You Pay 1 FIRSTHELP 24/7 NURSE ADVICE LINE Free advice from a registered nurse.
More informationThe Healthy Families Program Exclusive Provider Organization (EPO) Member Services Guide Evidence of Coverage
The Healthy Families Program Exclusive Provider Organization (EPO) Member Services Guide Evidence of Coverage Effective October 1, 2012 to September 30, 2013 Anthem Blue Cross is the trade name of Blue
More informationProvider Guide. Medi-Cal Health Homes Program
Medi-Cal Health Provider Guide This provider guide provides information on the California Medi-Cal Health (HHP) for Community-Based Care Management Entities (CB-CMEs), providers, community-based organizations,
More informationSummary of benefits Health Net. seniority plus green. Benefits effective January 1, 2009 H0562 Medicare Advantage HMO
2009 Health Net Summary of benefits Los Angeles, Orange, Riverside and San Bernardino counties s effective January 1, 2009 H0562 Medicare Advantage HMO Material ID H0562-09-0041 CMS Approval 9/08 Section
More informationOhio Medicaid Overview
Ohio Medicaid Overview May 2014 John McCarthy Ohio Medicaid Director Medicaid Overview Medicaid is Ohio s largest health payer 83,000 active providers, hospitals, nursing homes and other providers care
More informationGeneral indications for referrals to an Out of Service Area Provider include:
Purpose: To describe Central California Alliance for Health (the Alliance) authorization process for referral of Alliance eligible linked members to Out of Service Area and non-contracted specialty providers.
More informationBenefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Primary Care Physician Selection Optional There is no requirement for member pre-certification.
More information2018 SUMMARY OF BENEFITS
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Senior Care Options (HMO SNP) H2226-001 Look inside to learn more about the plan and the health and drug services it covers. Call Customer
More informationSacramento Medi-Cal Managed Care Advisory Committee
Meeting Minutes October 22, 2012, 3:00 PM 5:00 PM Sacramento DHHS Administration 7001A East Parkway Sacramento, CA 95823 Conference Room COMMITTEE MEMBERS x Chair Sandy Damiano, PhD x Hospital Patricia
More information1500 Capitol Ave. Sacramento, CA 95814
Health Net Community Solutions, Inc. Health Net of California, Inc. 1201 K Street, Ste. 1815 Sacramento, CA 95814 April 22, 2016 Ms. Sarah Brooks, Deputy Director Health Care Delivery Systems Department
More informationSummary of Benefits Report SENIOR CARE PLUS: VALUE BASIC PLAN (HMO)-009 January 1, 2015 December 31, 2015 WASHOE COUNTY, NEVADA
SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have choices about how to get your Medicare benefits One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare).
More informationMember Handbook. Combined Evidence of Coverage and Disclosure for Santa Barbara and San Luis Obispo Counties
Member Handbook Combined Evidence of Coverage and Disclosure for Santa Barbara and San Luis Obispo Counties CenCal Health 4050 Calle Real, Santa Barbara, CA 93110 1288 Morro Street, Ste. 100, San Luis
More information2017 Summary of Benefits
H5209 004_DSB9 23 16 File & Use 10/14/2016 DHS Approved 10 7 2016 This is a summary of drug and health services covered by Care Wisconsin Medicare Dual Advantage Plan (HMO SNP) January 1, 2017 to December
More informationCCS Claims Webinar Understanding and Navigating the CCS Claims Process CRISS May 3, 2017
Children s Regional Integrated Service System CCS Claims Webinar Understanding and Navigating the CCS Claims Process CRISS May 3, 2017 What is California Children s Services? Statewide program that coordinates,
More information2018 Benefit Highlights
Los Angeles, Riverside and San Bernardino Counties 2018 Benefit Highlights SCAN Connections (HMO SNP) Medicare Advantage Plan The SCAN Story SCAN, a not-for-profit health plan, was founded in 1977 by seniors,
More informationCOVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE
COVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE This is a list of all covered services and benefits for MassHealth Standard and CommonHealth members enrolled
More informationCalifornia Children s Services (CCS) Redesign Medical Eligibility
California Children s Services (CCS) Redesign Medical Eligibility Robert Dimand, MD Chief Medical Officer California Children s Services Systems of Care Division, Department of Healthcare Services - 1
More informationCAL MEDICONNECT: Understanding the Individualized Care Plan & Interdisciplinary Care Team. Physician Group Webinar Series
CAL MEDICONNECT: Understanding the Individualized Care Plan & Interdisciplinary Care Team Physician Group Webinar Series Today s Webinar This webinar is part of a series designed specifically for physicians.
More informationMAKING IT HAPPEN. WHAT IS MEDI-CAL? A Booklet for Regional Center Clients and Families
MAKING IT HAPPEN WHAT IS MEDI-CAL? A Booklet for Regional Center Clients and Families INTRODUCTION This booklet contains information about the Medi-Cal program. It provides a general overview of the program
More informationMedi-cal Part 2 Provider Manual For Soc Billing Instructions
Medi-cal Part 2 Provider Manual For Soc Billing Instructions Medi-Cal Provider Manual Contents 7,265 Bytes How to Use This Manual (0Bhwtouse) 18,979 Bytes Contents (Part 2 Medi-Cal Billing and Policy):
More informationCalifornia Children s Services Program Redesign:
California Children s Services Program Redesign: Vision, Goals and Groundwork for the Stakeholder Process September 26, 2014 Agenda 9:30-9:35 Welcome and Introductions Dylan Roby, UCLA 9:35-9:45 Opening
More informationStanislaus County Medical Benefits EPO Option. In-Network Benefits (Stanislaus County Partners in Out-of-Network Benefits
Stanislaus County Medical EPO Option The following summary of benefits is a brief outline of the maximum amounts or special limits that may apply to benefits payable under the Plan. For a detailed description
More informationDOA CM Standards Medi-Cal Preliminary Scoring
M-C/CM 1: Care Management Process (QI7/Element A) The Care Management Program and/or policy and procedure must include a written description of the process to coordinate services and help Members access
More informationEssential Health Benefits Addendum. Office of the Insurance Commissioner Washington State
Essential Health Benefits Addendum Office of the Insurance Commissioner Washington State 1 Details, details Classification of Services Classification of a service may affect the scope of the available
More informationManaged Medi-Cal Behavioral Health Benefits. Alliance Board Meeting October 23, 2013
Managed Medi-Cal Behavioral Health Benefits Alliance Board Meeting October 23, 2013 Purpose Discuss role of ACA in expanding benefits Review philosophy of integrated health care Review State policy process
More informationSpecial Needs Plan Model of Care Chinese Community Health Plan
Special Needs Plan Model of Care 2017 2017 Chinese Community Health Plan Elements of CCHP SNP Model of Care Special Needs Plan (SNP) Goals CCHP Dual Eligible SNP Enrollment & Eligibility Vulnerable Beneficiaries
More informationMedicaid SED Program
1 Medicaid SED Program Referrals Provider Self Other Independent Assessment Person Centered Plan Updates Ongoing Treatment Engagement Medicaid Eligibility CANS Updates Receipt of Services Access to Services
More informationCALIFORNIA Small Group HMO Aetna Health of California, Inc. Plan Effective Date: 04/01/2007. Aetna Value Network* HMO $30/$40
PLAN FEATURES Deductible (per calendar year) Member Coinsurance Lifetime Maximum Primary Care Physician Selection Referral Requirement PHYSICIAN SERVICES CALIFORNIA Small Group HMO Primary Care Physician
More informationCommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan): Summary of Benefits
This is a summary of health services covered by CommuniCare Advantage Cal MediConnect Plan for 2014. This is only a summary. Please read the Member Handbook for the full list of benefits. CommuniCare Advantage
More informationSummary Of Benefits. FLORIDA Broward, Hillsborough, Miami-Dade, Palm Beach, Pinellas, and Polk
Summary Of Benefits FLORIDA Broward, Hillsborough, Miami-Dade, Palm Beach, Pinellas, and Polk 2018 Molina Medicare Options Plus (HMO SNP) (866) 553-9494, TTY/TDD 711 7 days a week, 8 a.m. 8 p.m. local
More information